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- [00:00]
A
Hello, friends, and welcome to the Juice Box Podcast. I hope your Thanksgiving is calm and your boluses were spot on. In every episode of Bolus 4, Jenny Smith and I are going to take a few minutes to talk through how to bolus for a single item of food. Jenny and I are going to follow a little bit of a roadmap called Meal Bolt. Measure the meal, evaluate yourself, add the base units, layer a correction, build the bolus shape, offset the timing, look at the CGM tweak for next time. Having said that, these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of Meal Bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to juiceboxpodcast.com Meal Bolt. But for now, we'll find out how to bolus for today's subject. While you're listening, please remember that nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Today's episode of the Juice Box Podcast is sponsored by the Contour Next Gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you@contournext.com Juicebox I drugged Jenny onto the podcast when she wasn't supposed to record today. Hi, Jenny.
- [01:56]
B
Hi. How are you?
- [01:57]
A
I'm good, thank you. My lack of planning made me two weeks before Thanksgiving say, oh, shouldn't we have done something for Bolas4 for Thanksgiving? That would have been smart.
- [02:05]
B
Yay. That's fun.
- [02:07]
A
Yeah. Yeah. So I went out to the to the peeps and I said, like, you know, tell me some of the things that you guys are going to eat on Thanksgiving. I got, like, a little comprehensive list. I'm going to roll through it with you just very quickly.
- [02:19]
B
Okay.
- [02:19]
A
People eat roast turkey or ham. They seem to have stuffing in a couple of different ways. Cornbread stuffing, regular bread stuffing, sausage and oyster stuffing. Four separate ones. Oh, mashed potatoes. They have gravy. They have sweet potato casserole. Many of them appear to put marshmallows on top of it.
- [02:36]
B
Yes.
- [02:36]
A
Green bean casserole, cranberry sauce. Mac and cheese was a big one. Dinner rolls, roasted brussels sprouts, roasted root vegetables. Like carrots, you know, that's that thing you might know more about. People have salads, apparently. I would never eat a salad on Thanksgiving. Not when all those other food there. But that's fine. I mean, what am I gonna waste time with salad then Pumpkin, apple pecan, sweet potato, cherry pie, and cheesecake. These are the things that were given to me as a. As a list.
- [03:09]
B
Great.
- [03:10]
A
I tried to break them down into context for myself. Like, I basically said, like, what's a. What do you think the carbs are in a serving of? And I kind of have a list in front of me. And I'm interested to see. I'm interested to see if it matches how you would think of it off the top of your head. And then when I walk them through how to bolus for the whole day. Okay, Makes sense.
- [03:34]
B
Sure.
- [03:34]
A
Okay. Turkey does not have carbs in it. You agree?
- [03:38]
B
Turkey does not have carbs in it unless it was cooked a specific way to have carbs in it.
- [03:44]
A
Okay.
- [03:44]
B
But yes, it doesn't have carbs in it.
- [03:46]
A
I roast the turkey. I'm not gonna see carbs. A little bit of fat, maybe. It says maybe 4 grams for a typical serving. Bread stuffing, 40 grams of carbs for a cup. What would you say?
- [03:58]
B
You said bread pudding.
- [03:59]
A
No bread stuffing. Just regular stuffing stuff. You know what stuffing is? Would you eat stuffing?
- [04:03]
B
I hate stuffing. Okay. Like, you said all the stuffing options. I was like, nothing there would ever enter. Like, I wouldn't even pick the spoon up my eyeballs. BYP ask that, because wet bread is disgusting.
- [04:15]
A
I knew you were gonna say wet bread, by the way.
- [04:18]
B
Gross. Yeah. I'm so sorry. All the people who love stuffing. I mean, my parents liked stuffing. My mom still makes stuffing. If I'm gonna eat carbs, I'm gonna eat something that I want. And I don't like stuffing. But yes, that sounds approximately correct for a serving of stuffing.
- [04:33]
A
Okay. And now we do know that. And I'm gonna bring this up a couple times today. Just make sure. If you make stuffing the way I make stuffing. So, Jenny, the way I make it is I will bake bread this week. I'll make some wheat. I'll make some white. I'll make a number of different loaves of bread, a little rye. And then I will cut it up into little cubes and spread it out into big trays and let it get a little stiff.
- [04:59]
B
Dry.
- [05:00]
A
Yeah, yeah. Then I throw it into the oven to crisp them up. I make stuffing like that. And that stuffing goes. Turkey stock from the morning of I make my stuffing on the morning of I take the neck and the heart and the liver and I boil it in water with butter and seasoning. And so then I use that water to flavor the stuffing. Right. That stuffing will have a different impact on blood sugar than stovetop out of a box. Right. Because of the processed nature of it.
- [05:29]
B
Yes. Correct. It will.
- [05:31]
A
Same thing. If I make scalloped potatoes out of potatoes or if I make scalloped potatoes out of a box, we're going to see the stuff coming out of a box being a little more difficult. Correct. Okay. I just want to keep that in people's minds. Okay.
- [05:42]
B
Well, I think also a little bit more difficult because the box stuff, again, as we've gone over this before, has a lot more processed or packaging type of preservatives in that can have an impact in one way or another. Whereas scalloped potatoes that you've do all yourself and you know all the ingredients because you know all the ingredients. I think there's something to seeing what you put into an item.
- [06:08]
A
Yeah.
- [06:09]
B
That makes you also understand better how to navigate coverage when we're talking about something like insulin and managing and timing and all that kind of stuff. There just is.
- [06:19]
A
Yep. So I just want people to keep that in mind. If you're making these things fresh, it's going to be, you know, maybe one impact. And if you're making them from box stuff, it's. It might be a little more difficult because of the processed nature of the box food. So stuffing, you're okay with about 40 carbs. Now that's for a cup. How about sides? I've got 35 for a cup of mashed potatoes. That sound about right?
- [06:39]
B
That's about right. And an easy eyeball is, you know, again, nobody gets out unless you're my mother. When I was little and had all the serving spoons that were taken wherever we went for holidays. It is what it is. Right.
- [06:52]
A
I'm just laughing.
- [06:53]
B
I'm alive today because of my mother.
- [06:54]
A
I'm imagining your mom just like, you know, like when in one of those, one of those movies where someone shows up to like shoot somebody from a distance. Like they're. I imagine your mom like unfurling her tools in the kitchen. Yeah, yeah. Yes. You're stuff ready.
- [07:08]
B
An easier one is a female fist or a smaller size, like even like a teen sized or, you know, a woman's fist is about a one cup portion.
- [07:17]
A
Okay.
- [07:18]
B
So it's a really nice thing that you're carrying around with you. You don't have to get the serving spoon.
- [07:22]
A
Yeah, yeah.
- [07:23]
B
Okay, measure.
- [07:24]
A
So a fist of mashed potatoes. About 35.
- [07:27]
B
35 gram.
- [07:28]
A
Fists of corn stuffing or of stuffing. About 40.
- [07:31]
B
About 40. Yep.
- [07:33]
A
Sweet potato casserole. I have between 55 and 60 grams for a cup. And an indicator here that there's going to be a big, like, glycemic hit right away. A lot of sugar.
- [07:45]
B
A lot of sugar. Both from the way that the sweet potatoes were cooked to begin with as well as the marshmallows. There's usually extra, whether it's maple syrup or brown sugar that's added to it. I mean, it's like sugar on top of sugar on sugar.
- [07:59]
A
Yeah, yeah. And then green bean casserole. A cup 12 grams approximately.
- [08:04]
B
Any. Any 12 grams. I mean, again, that differs in making.
- [08:10]
A
The recipe I had here had like, it was used a soup mix and onion. So there's some hidden carbs in the onions in the soup mix.
- [08:16]
B
Yeah. But on average, I usually say that's an easy one. A fist again is like 15.
- [08:21]
A
Okay.
- [08:21]
B
It's probably easiest.
- [08:23]
A
Okay. Cranberry sauce says a quarter of a cup of canned cranberry sa. Oh, it's 22 grams of carbs, which is of. That is 21 grams of sugar. It's all sugar. Huh?
- [08:33]
B
It's all. It's all sugar. I mean, cranberries themselves, they really are nothing. They're really tart. Yeah, but it's all the. I mean, there's nothing cranberry in it except for the flavor and the juice that came out. And then you just put sugar in it and make it into like jelly.
- [08:49]
A
So before we get to the Mac and cheese, which I didn't realize was such a big thing for people, although my son said to me, like, is there going to be macaroni and cheese at Thanksgiving this year?
- [08:56]
B
We've never had Mac and cheese. That's never been a Thanksgiving ever.
- [09:00]
A
I didn't think of that either, but it was a big thing that people brought up. But I'm just want to point out that we've got the turkey so far. We've got the potatoes. We haven't even said gravy yet. So potatoes, sweet potato casserole, green beans, cranberry sauce. We're not even to the macaroni and cheese yet. If you had a serving of each of these, you're looking at 35, 90, 105. Oh, my gosh. 120. Plus the turkey, like, you're already up at like 130 carbs. Right, right, right. For for this stuff on your plate. And I don't think this is crazy to think that people might put no, you know, a cup of potatoes and this and that. Even if it was half, like, think about it. Like, even if you went half a cup of potatoes, half a cup of this, half a cup of that, you're still, you know, 60, 70, 80 carbs. Right.
- [09:51]
B
And you didn't even get into, you know, sometimes it's the meal. I know. Which you said, I'd never have salad for Thanksgiving. But you had maybe that's the. The beginning of the meal before the other major entrees. And what often comes with a salad are some type of roll or cornbread rolls or something like that that also adds into. Well, now I'm actually sitting down for the meal.
- [10:12]
A
Yeah, it's a good point. Cornbread roll, 26 grams for a square. Sound about right?
- [10:17]
B
They're pretty. Yes. They're in fact, a little bit more carby than, like, those tinier rolls that are more often served at a gathering like this. Like just bread roll.
- [10:27]
A
They're more like 20.
- [10:28]
B
They're like 20.
- [10:29]
A
Yeah. Okay, now, if you're gonna go crazy and have vegetables on top of that, don't forget something like Brussels sprouts. 12 grams for a cup. Creamed corn, 15 grams for a half a cup. Glazed carrots, 18 grams for a half a cup. Does that sound right? Jenny's not gonna eat creamed corn anytime soon. But am I right about that?
- [10:46]
B
Yes.
- [10:47]
A
Okay.
- [10:48]
B
No, no cream corn.
- [10:49]
A
Oh. To take all this stuff together and say, these bolus four episodes have been great because we've been breaking down like, hey, here's, you know, one food. Like, you're at the mall, you have a Cinnabon. Here's how you bolus for a Cinnabon. But what we're talking about here is between four and eight different foods all mixed up in your gullet at the same time. Do they all have different impacts or does it just turn into one big impact that, like, is it really just, like, are we really thinking about the foods individually or are we thinking about them together? The Contour Next Gen blood glucose meter is sponsoring this episode of the Juice box podcast. And it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right. If you go to my link contour next.com juicebox, you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger, and Meijer. You could be paying more right now through your insurance for your test strips and meter than you would pay through my link for the Contour Next Gen and Contour Next test strips in cash. What am I saying? MyLink may be cheaper out of your pocket than you're paying right now, even with your insurance. And I don't know what meter you have right now. I can't say that. But what I can say for sure is that the Contour Next Gen meter is accurate, it is reliable, and it is the meter that we've been using for years. Contour next.com juicebox and if you already have a contour meter and you're buying test strips, doing so through the Juicebox podcast link or will help to support the show.
- [12:36]
B
At a meal like this, you would have to think about their impact together. Because I think about the way that one of my uncles, when we had meals together, especially Thanksgiving, he would take, you know, like a roll and he'd put turkey in it. Sometimes he'd like dip it in his mashed potatoes and gravy and like take a bite full of it. Like all of the observations of a child, think back to the funny things that you watched happen at a dinner table. Right. But if I think about it that way, all of that is going into, as you. Funny, funny said the gullet. Right. They're all going down at one time and they all have a different impact. The bun is high glycemic because it's so just a processed thing. And then you've got turkey, which is all protein, pretty low fat, depending on how you cooked it or what's on it.
- [13:26]
A
Right.
- [13:26]
B
The gravy, which is depending again how you made it, a lower impact. And then you throw into it mashed potatoes and maybe the cranberry sauce went on the roll before the turkey did.
- [13:38]
A
Right. I'm with you.
- [13:40]
B
You do. It's a great. I. It's a great question because you would want to think about all of them individually, as we often do. But a meal like this, that is often also a very drawn out meal. You're eating a little bit of this, a little bit of that. Maybe you're forking it all together and putting it in. So we really have to consider it as a full effect meal.
- [14:01]
A
Yeah. So it's going to hit fast and long, Correct? Right.
- [14:06]
B
Yes.
- [14:07]
A
No matter what you do. Like I'm actually, while you're talking, I know people are like, it'd be nice if you were prepared before you started, Scott. But I'm putting together, I'm basically Putting a plate together right now of this stuff. Right. I'm going to put a dinner roll in there, and I'm going to put some vegetables in there. Watch what I do here. I'm gonna do. Let's see. Let's do glazed carrots. I know people love putting sugar on carrots. Okay. So I'm gonna say give me a total for all carbs. So I put in glazed carrots. I put in a roll. I put in Mac and cheese. In the way we just talked about it, I put in green beans, sweet potatoes, gravy, mashed potatoes, stuffing, and turkey. Okay. Okay. And I gave it all of its carb and all of its fat and everything else. Right. So the total carbs for that plate, the way we broke it down.
- [15:06]
B
Right.
- [15:07]
A
You want to guess? I'll give you a range to guess inside of.
- [15:11]
B
My guess would be somewhere between 150 and 200.
- [15:14]
A
It says 218 to 236 is the maximum. Okay. And it breaks.
- [15:19]
B
I clearly missed something that was on that plate.
- [15:21]
A
Well, it was roast turkey, 3 ounces, bread, stuffing at 40 carbs, mashed potatoes at 35. I have 6 grams for the gravy at a quarter a cup of gravy, which, by the way, a quarter cup of gravy, please. And then I have sweet potato casserole between 55 and 60 for a cup green bean casserole, 12 Mac and cheese, 32 to 45, dinner roll, 20 glazed carrots. 18. Right?
- [15:46]
B
Yeah. I think it was the glazed carrots that I didn't. I didn't add in all the other ones I was adding in my head.
- [15:51]
A
I missed the place. Also, you're really awesome at this, by the way. People should know. I don't give Jenny any help while we're making this at all. I don't let her see anything. She doesn't know the numbers I'm talking about. I'm turning her into your avatar. It's what I'm trying to do while we're talking about this. Yeah, so I've got that. And then I'm just gonna say to it this, right, Watch this. I'm gonna tell it to go to juiceboxpodcast.com/meal bolt, meal-bolt, and apply that to this meal. Because you guys could do this too, is my point. I'm just gonna let Chachi P2 do that while I. I fill some people in on Another thing that ChatGPT and other large language models. Like, I don't care which one of these algorithms or which one of these My God, why can't I think of the word all of a sudden? What's going to ruin the world, Jenny?
- [16:44]
B
What's going to ruin the world? Oh, well, there are a lot of things in the world.
- [16:49]
A
All right, so watch this. All right, no matter which one of these models you use, I'm just going to type in algorithm. Yeah, Sweet potato recipe with marshmallow. Because I don't have one. I'm just going to grab one from the interwebs.
- [17:04]
B
I have never made that.
- [17:05]
A
I'm going to use the one from Candied sweet potatoes from all recipes. I'm going to click on. I'm going to click on print so I can just do a drag up on the ingredients. 4 pounds of sweet potatoes, quartered. 3 cups of miniature marshmallows, divided. A cup and a half of butter. A cup and a quarter of brown sugar. Oh, my God.
- [17:21]
B
A cup and a half of butter.
- [17:22]
A
I'm just telling you what I. Hold on a second. I'm gonna put that in here and I'm gonna say to it this, please give me a nutritional breakdown. Okay. And so it's gonna, it's going to take those, you know, quarter cup of this, cup of that. Whatever it is, it's going to tell you there's this many carbs in it, this much sugar in it, blah, blah, blah. Because you guys like, I mean, this is pretty. I don't know how many people are going to do this. I think you could probably just go from a cheat sheet that says, which by the way, I'm going to put the cheat sheet up. Look for the cheat sheet on the Facebook group and on the, on the website today for Thanksgiving. If you're listening to this on Thanksgiving. But I want you to know that you could head out to one of these and have it break it down for you and it'll give you some pretty, pretty reasonable places to start. Right. So the, so the Thanksgiving bolt formula that came back, it said, right, if your BG is 90 to 120 when it starts, it'd like to see your pre bolus 20 minutes, dosing about 60 to 70% up front and doing extended or split drag the remaining 30 to 40% over the next two to three hours. Does that sound reasonable to you?
- [18:32]
B
Sounds reasonable.
- [18:32]
A
Okay, it should because we're the ones that made the meal bowl thing.
- [18:35]
B
Yes.
- [18:36]
A
If your BG is rising, you can try before the meal pre bolus a little longer, 25 to 30 minutes for, and maybe add 10 to 20% to the total dose. So if you're rising before the meal, get ahead of it a little further. Try to stop it from going up before you eat.
- [18:53]
B
Or within that just a secondary would be add a corrective without any food consideration so that you actually get that to turn around. Especially if you're at a meal where you're not quite sure exactly what you're gonna sit down to and what you're gonna eat first, then just correct what's going on.
- [19:10]
A
Perfect. If your blood sugar's falling before the meal, you could start eating sooner or only give 50% upfront. Deliver the rest over maybe two hours. Use the natural fall that you're experiencing. If you are experiencing one as part of your pre bolus. Now it says if you're grazing for hours, increase your basil by 10 to 20%. You do you do a basal increase.
- [19:30]
B
For Thanksgiving when pre current algorithm that I use and actually with the algorithm just called something different, right? My Thanksgiving and we celebrate Christmas. So my Christmas, when we were getting together, family, lots of stuff. My day was coded by 25%.
- [19:51]
A
Okay.
- [19:52]
B
So I did a basal increase of 25% and that helped me navigate because what we're also kind of hinting around here, while you can do a good job of looking things up with today's technology. Thankfully, when I was there, there wasn't as much information to be able to look up. And it was a lot more imprecise estimation. And even today, I think a lot more people end up doing, oh, it looks about like this, right? So I found that that 25% increase not only helped because of the grazing nature and the long duration of intake, but it was because I was absolutely not weighing and measuring things. It was all an estimated guess. That looks like 30 grams, looks like 20 grams.
- [20:38]
A
A little more. A little. I always say go heavier, but that's me. What about people who say that like I try to give myself more insulin, but I always end up low later? What do you think's happening to them? Like colloquially like I obviously we're not with them, but what are you doing if you're ending up low later in the day?
- [20:54]
B
Depends on when later, right? It could be that one, the amount of extra you gave was just too much or you were more in the category of over over calculating the amount of insulin, not the amount of insulin, but the number of carbs. And so then you were getting more insulin that you needed. The other consideration in it could be that maybe you are also the one hosting the gathering and you're on your feet and you're busy and you're moving and you're lifting things in and out and whatever it might be, it could be that what you've experienced in the past, not hosting, now you're on your feet and you didn't need as much. So I mean it could be a bunch of variables. But in general, if you're getting low, there's too much insulin and there wasn't enough food to cover it. I mean that's the base.
- [21:39]
A
So I'm going to go back here to the sweet potato breakdown. First of all, the breakdown is extensive. You don't obviously need this much information that it gives back. But if you really wanted to understand nutritionally what's in that sweet potato thing, my goodness, it like really, it really gave me a return here. It tells me the sweet potatoes, the net carbs for the sweet potatoes, glycemic index, glycemic impact for the marshmallows, the brown sugar, the butter, the whole thing, it tells you the total estimated glycemic load for the whole panel for a serving. It's really, really lovely. For the whole pan. If you ate the whole pan of sweet potatoes from that recipe, you'd have a glycemic load of 463. There's 12 servings in the pan per serving. It's 39 glycemic load per serving, which is, you know, so.
- [22:30]
B
And that, which is high glycemic load. Very high.
- [22:33]
A
That is, I mean the context. Low is under 10, medium is 11 to 19, high is above 20. Now keep in mind like Jenny knows this because she went to school for it and she's smart. I don't know any of this. I just typed it into the machine and it's giving it right back to me like, so it's, it's valuable.
- [22:49]
B
Well, and I know that we did define glycemic load versus glycemic index, right? This nice little chat thing is giving you a little bit of both. It's a high glycemic index, but when you break it down and you say, okay, it's high glycemic index, but gosh, I really just want to taste it. Maybe I'll have a tablespoon of this. Then the glycemic load is absolutely much lower than over 20.
- [23:15]
A
But it's also telling me here that like if you were going to eat this by yourself, like just have the sweet potato thing, you'd need a maybe up to a 30 minute pre bolus for this. So now.
- [23:27]
B
Absolutely right.
- [23:27]
A
So now all of a sudden, if that's Mixed in with the rest of your meal. The 10 to 20 minute pre bolus for food isn't really going to help. And by the way, you all know what's about to happen. You're going to be running around putting stuff on the table. And as you're walking towards the table, one of you is going to yell across the room, billy, did you give yourself insulin too late. It's already too late. Everything's a bumfuzzle at that point. Now you're a half an hour late. If you're gonna have the sweet potatoes and then the spike's gonna happen, you're gonna go crazy trying to knock the spike back down or you're gonna live with it. It's gonna ruin your day. It's gonna, you're gonna be upset. I'm telling you, for me, it's funny. Jenny and I talked about this. We're like, are we gonna talk about it with numbers? Or I think of this, I think you get up in the morning, you get ahead and you stay ahead, right? You use increased temp basils, you make sure to pre bolus the first couple things that you're eating and then after that you just cover stuff as you're eating it. And you should have the insulin. The way I think of it, like on your side, on the momentum side for you. And then you just gotta have the kind of wherewithal to realize when to shut that basil off and not make yourself low afterwards. And if you're gonna have a dessert later in the day, it's gonna be high glycemic index. You need a nice long pre bolus for it. That's it. I mean, and then don't go to bed and sleep too sound. Turn all your alarms up.
- [24:48]
B
Well, and it may be a night that you turn your alarms up in terms of the low alert, right? You have your low Alert set for 65 or 70 and you're not quite sure exactly what the lingering effects of this meal are gonna look like. Then set your low alarm much higher so you can catch it faster. Right? Or the high alarms. Set your high alarm a little bit lower so you can catch it. And you can. Again, catching something on a rise versus waking up with a 200 plus blood sugar because your alarm was set for 200, it saves you time to navigate adding more insulin when it's needed sooner than later.
- [25:25]
A
Yeah. I'm going to point out before I move on from this, that doing that chatgpt breakdown of that recipe per serving, it assumes 12 servings. Right? But you're getting 433kcal calories from it 64 carbs from a serving 5 grams of fiber 39 grams of sugar net carbs 59 protein 3 1/2 fat 19.5 saturated fat 12 monounsaturated 5 polyunsaturated 0.7 cholesterol 51mg sodium 220mg potassium 750 calcium 77 iron 1.2. That is from taking that recipe, dropping it in there and going, hey, break this down for me.
- [26:03]
B
Nutrition, right?
- [26:05]
A
So when you're find yourself listening to these other bolus for episodes, you're like, oh, this is interesting, because I'm getting a lot of good feedback from them. People are interested in, like, that's chatting through, like, how to bolus for something. Just realize, like, there's way more impact from this stuff than you think. Now, we picked. I picked, you know, something with a ton of sugar, the hardest.
- [26:24]
B
And actually it makes me think of going back even in just a bit ago, you know, like Billy or whatever his name was, Bolas. And he's already sitting in, like, the meal is coming, right? Well, what could you do if Billy is so willing to do it? Start with the turkey then, right? Start with the. So you can give the bolus. You can let Billy decide what he wants on the table. Start with the turkey or the proteins, if it's ham or whatever your protein source might be, because that's going to have a very low glycemic hit, and you then at least build in a little bit of time that the insulin is going to have to get moving before you have your sweet potatoes with marshmallows.
- [27:07]
A
Try to put the sugar at the back. If you can.
- [27:09]
B
Put the sugar at the back. Exactly. Yes.
- [27:11]
A
I have to tell you that this is. I mean, there's part of me that wants to break each one of them down. I wish you guys could have heard us talking before we started. Like, there is a way to break down, like, mashed potatoes. Like, this is how I'd bolus for mashed potatoes. But once you start mixing stuff together, in the end, it's a. It's a lot about the impact. It's about how quick it's going to hit you and for how long it's going to hit you. It's about pre bolusing, staying ahead of it. And I, you know, for me, again with the, you know, temp basil, which a lot of your algorithms, it's. It's kind of a catch 22 on Thanksgiving, right? Because everybody's going to be on their automated systems. You can't just tell it to, like, more, you know. Yeah, it's. It's not going to want to do that. I don't know, like, what I would do in that situation.
- [27:52]
B
Another piece to this, too, would be, what do we follow up the main meal with? We follow it up with, you know, if we're going to break anything down, Some type of a dessert or a sweet treat ends up coming in at the end of the meal.
- [28:05]
A
Yeah.
- [28:06]
B
Now, what precedes this, a load of insulin is already there. You have maybe coated it with, whether it's an extended bolus or a temporary basal increase or some type of override that your system allows you to utilize. And now you might be coming into a dessert time thinking, well, that looked pretty sweet. Like, look at the great job that I did. But you still have a load of fat that's loading that food down from completely clearing through and having a completed impact before you eat your. Let's call it pecan pie.
- [28:40]
A
Okay.
- [28:41]
B
So I think there's consideration for what do you do with the dessert at the end?
- [28:46]
A
Right.
- [28:46]
B
And it does go back to where. Where are you sitting? What does it look like is happening to your blood sugar? What's the direction? Are you nice and stable? Are you stable but just starting to kind of edge up? Are you stable but starting to nose down? Are you low already from whatever, you know, was miscalculated because it is what it is. So I think it's another place to consider how you distribute that dessert type of a bolus and the timing around it.
- [29:15]
A
Pies are, I guess, a good example. Right. Like, so there's filling, like pumpkin. Like, I'm looking at a pumpkin pie here. I guess we could break one down to, like, to see what's in it. Right. Hold on a second.
- [29:26]
B
What's in it? I mean, the most common are what, pumpkin and apple pie. Those are the ones that we've always had at mine. Pecan pie. We've never had it. My Thanksgiving. It's a huge Thanksgiving thing. But I don't even ever think I've ever had pecan pie in my life.
- [29:42]
A
My grandmother was Pennsylvania Dutch. They used to eat something called shoofly P, which I. Molasses, right?
- [29:49]
B
Yeah. Again, all sugar. Yeah, essentially.
- [29:53]
A
Also, she had type 2 diabetes. I would just want to point out. So now I'm looking back, and that might not have been so hard to figure out why that happened to her. Okay. So I have. Right now, there's not a Lot in pie dough. I hope you're all making your own pie dough. I make mine.
- [30:07]
B
It's easy to make.
- [30:08]
A
It's not that hard really. Okay, so I am. I've gotten a breakdown here for. Well, hold on a second. It would be nice if the. If the website didn't launch a video on me. What? Is that ridiculous? By the way, all these recipe websites are just scams to get you to ads.
- [30:27]
B
Oh, of course.
- [30:28]
A
That's all it is. It's so hard to find the actual recipe. It's almost insane. You have to hit the by the way, you hit the print button. That's what I do. Okay, so here is the pumpkin pie filling. I gave it here, I'll give it to you. The recipe is 3/4 of a cup of granulated sugar, a teaspoon of ground cinnamon, quarter teaspoon of salt, quarter teaspoon of ground ginger, half a or quarter teaspoon of cloves, 2 eggs, 15 ounce can of pumpkin or fresh pump and puree, and 12 ounces of evaporated milk. It parsed down the this way. Granulated sugar, 150 grams for three quarters a cup. There's negotiable in cinnamon, sodium, of course, ginger, cloves, blah, blah, blah. 100 grams in the eggs, 425 grams in the puree, 354 grams in the evaporated milk. Makes an eight palm piece serving. So let's see. Whole batch per serving per slice, 149 calories, 27 carbs, 23.
- [31:32]
B
Oh, that's light on the carbs.
- [31:34]
A
23. Sugar. It doesn't include the crust.
- [31:37]
B
Oh, I was gonna say gosh, because that seems awfully light on the carb.
- [31:42]
A
This is just the filling. Now I'm gonna let it do the crust for you. Okay. It takes a second. I mean, here it comes. Well, technology is amazing. I don't know why we're all arguing about it. So what if it blows up the earth? I mean, look how quickly it broke this down. All right, so nutritional breakdown for the the crust, which by the way was two and a half cups of all purpose flour, a half a tablespoon of sugar, salt, half a pound of cold unsalted butter, some ice water. The entire concoction is. Looks like 300 for the flour, 6 for the sugar. And moving on here, let's see. Okay, hold on. Total carbs for the entire pie crust, 219 per serving, 27 for the crust, net carbs, 26 protein, 4. So yeah, it's basically 27 for the crust 26 for the filling. It's over 50 for a slice of pie.
- [32:41]
B
Yeah, I was gonna say the average is about 50, 50 grams. If you're just wanting a nice round number. 50 grams for an eighth of a.
- [32:49]
A
Piece of pie could do all this. Or just ask Jenny and she would have told you. I want people to be able to go do it for themselves afterwards.
- [32:56]
B
Yeah, no, it's a fantastic way to be able to do it and get the direct information.
- [33:02]
A
If Jenny can't live in your pocket and jump out and go, that's pie. 50. Jenny in your pocket.
- [33:13]
B
Oh, there. There you go. That would be a.
- [33:16]
A
Maybe we could solve that. Break your different pies down this way. Listen, is this exactly how your pie is going to be or how your potato. It's not. But it should give you enough. Right. Of a jumping in space for the carb total and the sugar understanding should get you close. Right. Like that's my hope for you is to be close again, get ahead, stay ahead and be ready for a low later. That's pretty much my whole Thanksgiving theory.
- [33:40]
B
And this as I brought it up, at the end of a long duration meal, that's a really heavy meal. This also brings in the consideration of not only the bolus, but the timing of the delivery of the bolus. It may be a time when you actually do, despite it being piece, it's sitting on top of butter and gravy and creamy stuff and fat in a heavy meal. So you may actually use 100% extended bolus for something like this, depending on where you're starting with your CGM value and the trend. Would you normally do this if you just sat down to a piece of pumpkin pie? No, in and of itself. By itself, absolutely. You would need pre bolus and you would. Right. But because of the end result of meal on top of this in your.
- [34:30]
A
Belly, I say make a blanket of insulin over top of the timeline of the meal. That's kind of how I think about it. Like seriously, like a weighted blanket for, you know, people with, you know, people like weighted blankets. I just put a. Yeah, just put a blanket of like insulin over top of the syrup. Pulling up some other things that people might find interesting. Regular Budweiser has 10 and a half grams.
- [34:52]
B
That's a great one to bring up. Of course a lot of people don't cover drinks.
- [34:56]
A
And a bud light has 6.6. I just randomly picked up beer. I don't drink beer, so I didn't know what to do there. And please, you know, if you want this to be easier. Don't drink sugared soda, don't drink juice, cider. I mean, do people do apple cider still?
- [35:12]
B
I would expect so, yes.
- [35:14]
A
You know what I mean? Apple cider's got to be crazy.
- [35:18]
B
It's pretty high carb. Usually depending on the brand, it could for a cup somewhere between 30 to 40 grams of carb. Just for a cup of apple cider.
- [35:28]
A
Yeah. And I mean, so, I don't know, like, good luck, I guess. Get out there and start swinging.
- [35:34]
B
Enjoy.
- [35:35]
A
Yeah. Have a great time.
- [35:36]
B
Be thankful for all we have.
- [35:38]
A
Jenny, let me ask you one question.
- [35:39]
B
Yeah.
- [35:40]
A
I'm sitting here now. It's not me and you. It's me and some newly diagnosed family, Right?
- [35:46]
B
Sure.
- [35:47]
A
And they've never Bolst this much in their entire life. They're going to sit there. I know what they're going to do. I've done it. Right. They're going to err on the side of caution. The kid's going to get high. They're going to have a whole like, look what happened, we ruined Thanksgiving. How do you find the nerve to make a, an 80 gram bolus when you've never done that before? What do you, you know what I mean? It's, it's a ballsy move. It really is. Is there a way to like go into it slowly? Can you?
- [36:12]
B
Well, I think with technology being the way that it is, you add it up, you've done the math and you look at it six times and you're like, Gosh, 80 grams. Like, we never bolus for this much. Like, you said you could do an extended bolus because then you're not getting the load of it despite good counting that you know that this is how much it actually is. Do an extended bolus and when you see that it's been working but now, gosh, my blood sugar clearly is going up, you can always cancel an extended bolus and take that as a normal bolus.
- [36:46]
A
Yeah.
- [36:47]
B
So that's one stepwise approach. Is it likely that your blood sugar might end up getting low later? It is. But again, with so much food around and so much quick carb, this would be the time to drink the apple cider.
- [37:00]
A
Yeah.
- [37:00]
B
Right, right.
- [37:01]
A
I mean, that is the other high side of all this is if you're too aggressive, there's a thousand ways to fix it. And it's all right there too.
- [37:08]
B
Right. But I think getting up the nerve, it does. Depending on the type of person, personality you have, and if it's yourself versus you navigating a Child. I think they're very different considerations.
- [37:21]
A
Yeah, no, for sure. I'd like to also bring up to people, please put the tiniest bit of effort into making sure that you're not in the last three hours of your CGM on Thanksgiving or that this isn't the last six hours of your pump site, like that kind of stuff. Like, I, I would love you not to have a brand new pump site and not an old pump site on Thanksgiving. I think that gives you a lot better chance, you know, just kind of be ahead of your tackle a little bit.
- [37:44]
B
I would like to add a note as well to try to start your day with some exercise because it can really help.
- [37:53]
A
Okay. Jenny.
- [37:54]
B
Everybody goes like, what? Come on, we drive.
- [37:58]
A
Don't I watch the parade?
- [37:59]
B
I don't. I haven't watched the parade in a long time.
- [38:01]
A
Let me tell you how my wife ruins the holidays with her. She's got some old family tradition where they eat these. I'm sorry, if she hears this, like, these, these garbage, like cinnamon icing rolls, like. Jenny. Okay, yeah, yeah, no, no, hold on. So right away in the, like, do you know what I'm talking about?
- [38:21]
B
A can where you pop them open and they. Yes, okay. Yeah, I know what you're talking about.
- [38:26]
A
You know what I'm talking about.
- [38:27]
B
Yeah.
- [38:27]
A
I had to learn. But also it helped me because, like, because for my wife, Christmas morning is like these. I'm not going to say what I almost said, but she. It started with these cinnamon rolls that were not, you know, they're not homemade. They're not from a. They're not even from a bakery. They're. They're, you know, out of a can, processed like, blah, blah, blah. And, you know, it's. Come downstairs, make these things, you know, Arden's just awake and they're going to eat cinnamon rolls. So, like, while everybody else is like running down the steps like, oh, it's Christmas.
- [38:56]
B
I'm like, bolus, we need insulin.
- [38:58]
A
I'm pre bolusing for the rolls. Right. And so she. And that's a. Every holiday like that, they would do those in the morning. And I think people have all kinds of stuff like that. Like, so, you know, it's. Your other idea too is like, if you're getting up on Thanksgiving and you're going to be at your aunt and uncle's to watch the melee at two and, you know, that's when lunch starts. I wouldn't start the day with a bowl of Captain Crunch.
- [39:20]
B
Right.
- [39:20]
A
Give yourself a shot is what I think. What I'M saying. And just don't get behind. I know that this sounds overly simple, but get ahead, stay ahead is such a great idea for days like this, you know, I really find it is.
- [39:33]
B
No, it's great.
- [39:34]
A
Okay. Apple cider. Yeah. 30 grams of sugar, 32 carbs for a cup hard apple cider. Don't forget that with alcohol in it. Can be there. Try not to drink your carbs, please. That'll help.
- [39:48]
B
Drink water. Lots of water.
- [39:50]
A
Water's terrible.
- [39:52]
B
Get some sparkling water.
- [39:53]
A
Tastes like water, I think is the problem.
- [39:56]
B
Tastes like water. Yeah. Add some, I don't know, add some lemon juice to it or some lime.
- [40:01]
A
That's a nice idea. Yeah. Some mixed berries in there or something.
- [40:06]
B
Right. Or, you know, squeeze and squeeze a couple slices of orange into it. It's not going to add anything you have to bolus for, but it adds a little flavor.
- [40:14]
A
Also, don't forget, when you do your leftovers after Thanksgiving, the cold potatoes will hit differently than the hot potatoes hit.
- [40:20]
B
That's a good point. Yes.
- [40:21]
A
Thank you. Look at us. We're like little fairies just dripping, dripping knowledge, knowledge every which way. Thank you for doing this, Jennifer. Happy Thanksgiving.
- [40:30]
B
Thanks for asking. You too. Thank you.
- [40:38]
A
I'd like to thank the blood glucose meter that my daughter carries, the Contour Next gen blood glucose meter. Learn more and get started today@contour next.com juicebox and don't forget, you may be paying more through your insurance right now for the meter you have than you would pay for the Contour Next gen in cash. There are links in the show notes of the audio app you're listening in right now and links@juiceboxpodcast.com to contour and all of the sponsors in each episode of the Bolus four series. Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the Meal Bolt formula. M E, A L B O L T. You can learn more about it@juiceboxpodcast.com meal-bolt but here's what it is. Step 1 M Measure the meal E Evaluate yourself A. Add the base units L Layer a correction B. Build the bolus shape O Offset the timing L. Look at the CGM&T tweak for next time. In a nutshell, we measure our meal total carbohydrates, protein, fat. Consider the glycemic index and the glycemic load. And then we evaluate yourself. What's your current blood sugar, how much insulin's on board and what kind of activity are you gonna be involved in or not involved in? You have any stress, hormones, illness, what's going on with you? Then a we add the base units, your carbs, divided by insulin to carb ratio. Just a simple bolus. L layer of correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the bolus shape. Are we going to give it all up front 100% for a fast digesting meal, or is there going to be like a combo or a square wave bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal or maybe 20 minutes? Are we going to have to again consider combo, square wave boluses and meals? Figure out the timing of that meal and then l look at the cgm. An hour later, was there a fast spike? Three hours later, was there a delayed rise? Five hours later, is there any lingering effect from fat and protein? Tweak, tweak for next time. T what did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus 4. Measure the meal, evaluate yourself, add the base units, layer a correction, build the bolus shape, offset the timing, look at the cgm, tweak for next time. But it's not going to be that confusing and we're not going to ask you to remember all of that stuff. But that's the pathway that Jenny and I are going to use to speak about each bolus. Have a podcast, Want it to sound fantastic? Wrongwayrecording. Com.